The BAL-Score Almost Perfectly Predicts Testicular Torsion in Children: A Two-Center Cohort Study

• Main Authors: Michaela Klinke (Author), Julia Elrod (Author), Carolin Stiel (Author), Tarik Ghadban (Author), Julia Wenskus (Author), Jochen Herrmann (Author), Carl-Martin Junge (Author), Konrad Reinshagen (Author), Michael Boettcher (Author)
• Format: Book
• Published: Frontiers Media S.A., 2020-12-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 2296-2360; 10.3389/fped.2020.601892
• Keywords: testicular torsion; acute scrotum; prediction score; epidydimitis; hydatide torsion; scrotal edema; Pediatrics; RJ1-570
• Source: Frontiers in Pediatrics, Vol 8 (2020)

Introduction: Testicular torsion (TT) is a common emergency that warrants immediate exploration to prevent infertility or testicular loss. To improve diagnostic reliability, various scoring systems have been published. The aim of this study was to evaluate and validate different testicular torsion scores in a large cohort of children with acute scrotum.Methods: Retrospective analysis of all male children that were admitted for acute scrotum at the Pediatric Surgery Department of the Altonaer Kinderkrankenhaus and University medical Center Hamburg-Eppendorf from 01/2013 to 03/2019. Two testicular torsion scores (Boettcher Alert Score, Testicular Workup for Ischemia and Suspected Torsion Score) were applied to all data sets. Furthermore, an artificial intelligence (AI)-based score was developed and compared to the two current scores.Results: In total, 460 boys were included in the study. Of those, 48 (10.4%) had TT. Children with TT suffered most often from short duration of pain, nausea and vomiting, high riding testicle and absent cremasteric reflex. The BALS and the AI-based score had excellent predictive values and all patients with TT would have been detected.Conclusion: The BAL and the AI score show excellent predictive capabilities and may be used to identify all cases of TT in a pediatric population. The scores are easy to apply. As the BALS was slightly better, we advocate to use this score but to validate our findings in prospective multicenter studies.